Clinical Feasibility of Digital Breast Tomosynthesis: Analysis of Observer Performance Background: Digital breast tomosynthesis (DBT) is considered the latest and most promising development in breast cancer imaging. In clinical pilot studies DBT has demonstrated higher sensitivity and specificity over projection mammography, which is presently the breast cancer screening tool of choice. Importantly, DBT will be provided at a relatively modest premium compared to existing digital mammography (DM) systems. For these reasons it has been widely suggested that DBT will replace DM in the diagnosis of breast cancer;some further believe that DBT may replace mammography in screening breast cancer. A practical concern for implementation of DBT is the radiologists'review time because DBT generates approximately 50 times more images than mammography. An increase in review time might significantly impact the breast cancer screening capacity and thus access to screening. Objective: Our aim is to obtain insight into the likely success of DBT as the population breast cancer screening modality of choice by comparing the radiologists'performance to interpret DBT images with DM images for the detection of breast cancer using time-controlled viewing experiments. The time-controlled viewing conditions will provide an unbiased perceptual viewing situation to compare whether 3D DBT facilitates perceptual recognition of breast cancers compared to 2D DM. We will also record the eye positions of radiologists as they view DBT and DM cases. The eye position analyses will provide a rigorous metric that will enable the quantitative measurement of the radiologists'performance. These will help to understand the current status of review issues so that they can be better addressed in future studies. Specific Aims (SA): SA1: Develop a platform to display DBT and DM cases under time-controlled viewing conditions. SA2: Compare for DBT and DM the radiologists'breast cancers detection performance under time-controlled viewing conditions and analyze the eye positions. Study Design: SA1: Task 1: We will modify our existing display hardware and software to allow equally short presentation times (2 s and 4 s) for DBT and DM images. Task 2: We will design a graphical user interface for the radiologists to report their decisions after each time-controlled viewing. SA2: Task 1: An experienced MQSA-certified radiologist will select a set of paired DBT and DM images of 100 breasts. Task 2: Four experienced MQSA-certified radiologists will review the images during short time-controlled presentations while their eye positions are tracked. Task 3: We will process the eye-position data. Task 4: We will compare the radiologists'breast cancer detection performance and the analyses on the eye-position data between DBT and DM. PUBLIC HEALTH RELEVANCE: This proposal aims to investigate the potential of digital breast tomosynthesis (DBT) as a population screening modality. We will focus on comparing radiologists'performance to rapidly interpret DBT cross-sectional images in stack mode with DM projection images for the detection of breast cancer using short time-controlled viewing experiments.